[Effect of conservative treatment in the management of low-degree urogenital prolapse]. / Apport du traitement conservateur dans la prise en charge du prolapsus urogénital de bas grade. Le devenir après deux ans.

OBJECTIVE: The objective of our study was to determine the respective effects of conservative treatment (pelvic muscle exercises plus advice on healthy living) and the absence of treatment in the management of urogenital prolapse. MATERIALS AND METHODS: Forty-seven women (mean+/-S.D. age: 53.42+/-11.01 years) consulting for genital prolapse (grade I or II cystocele) were randomized into two groups: a conservative treatment group (CTG) and a nontreated group (NTG). The patients' outcomes were rated according to several parameters; a clinical examination, the "Measurement of Urinary Handicap" (MUH) scale, urodynamic tests, the Ditrovie quality of life scale and patient satisfaction on a visual analogue scale (VAS). RESULTS: The immediate post-treatment results showed that pelvic heaviness persisted in only five patients (18.51%) in the CTG compared with fourteen (70%) in the NTG (p<0.001). Furthermore, a significant improvement in the MUH scale score was noted in the CTG compared with the NTG. The Ditrovie score also improved. The maximum urethral closure pressure (MUCP) ranged from 54.4+/-13.23 to 57.81+/-12.8 cm H(2)O in the CTG versus 54.05+/-12.18 to 52.95+/-12.18 cm H(2)O in the NTG. Uroflowmetry revealed a significant improvement in the maximum flow rate. These benefits were maintained two years after cessation of the conservative treatment in 20 of the CTG patients. CONCLUSION: Conservative treatment can be effective in the treatment of low-degree urogenital prolapse and enables the improvement of clinical symptoms and urodynamic parameters. The benefits were maintained two years after treatment cessation.

A study of isokinetic trunk and knee muscle strength in patients with chronic sciatica.

OBJECTIVE: To evaluate trunk and knee muscle strength in patients with chronic sciatica. PATIENTS AND METHOD: Twenty-eight patients with right-side chronic sciatica (group 1, G1) and 40 healthy controls (group 2, G2) were evaluated using an isokinetic dynamometer (Cybex Norm II). Quadriceps and hamstring muscle strength were evaluated at concentric velocities of 60 and 120 degrees /s and the trunk muscles were evaluated at concentric velocities of 60 and 90 degrees /s. RESULTS: G1 comprised 15 women and 13 men (mean +/- SD age: 34.787+/-6.06; weight: 65.85+/-5.33kg; height: 165+/-6.92cm). G2 comprised 20 women and 20 men (mean +/- SD age: 35.92+/-6.66; weight: 67.07+/-6.12kg; height: 165.82+/-7.65cm. There were no significant inter-group differences concerning these parameters. In G1, the peak torque values for the trunk extensors were 123.71+/-32.45 and 108.85+/-32.07 Newton metres (Nm) at angular velocities of 60 and 90 degrees /s, respectively. In G2, the values were 192.73+/-64.24 and 168.65+/-53.96Nm, respectively. In G1, the peak torque values for the trunk flexors were 134.32+/-30.77 and 124.39+/-32.59Nm at angular velocities of 60 and 90 degrees /s, respectively. In G2, they were 177.44+/-44.1 and 157.81+/-39.01 Nm, respectively. The difference between G1 and G2 was statistically significant. The peak torque for the right quadriceps in G1 was 100.03+/-24.45 and 78.71+/-22.92Nm at angular velocities of 60 and 120 degrees /s, respectively. In G2, these values were 160.5+/-36.34 and 131.05+/-33.42Nm. The peak torque for the hamstrings in G1 was 56.42+/-13.02 and 50+/-13.55Nm at angular velocities of 60 and 120 degrees /s, respectively. In G2, these values were 97.77+/-33.32 and 84.72+/-31.41Nm. Again the difference between G1 and G2 was statistically significant. We also noted a statistically significant difference between G1 and G2 in terms of the peak quadriceps and hamstring torque values on the left side. In G1, the quadriceps and hamstrings were significantly weaker on the sciatica side than on the unaffected side. CONCLUSION: The present study demonstrated trunk and knee muscle weakness in patients with chronic sciatica, when compared with healthy subjects. This weakness was predominant on the sciatica side. Consequently, the management of these patients should include a knee muscle reinforcement programme.

[The contribution of capsular distension to the treatment of primary adhesive capsulitis of the shoulder: a comparative study versus rehabilitation]. / Apport de l'arthrodistension dans la prise en charge de la capsulite rétractile primitive de l'épaule : étude comparative versus rééducation.

OBJECTIVES: To describe the epidemiological and clinical features of patients with primitive adhesive capsulitis of the shoulder treated by capsular distension and then rehabilitation; to evaluate the short-, mid- and long-term efficiency of this therapeutic protocol and compare it with rehabilitation alone. MATERIALS AND METHODS: This was a two-year prospective study. Sixty patients were included and divided into populations P1 (capsular distension and rehabilitation) and P2 (rehabilitation only). Assessment of the treatments' efficacy was based on the following parameters: pain on a visual analogue scale (VAS), joint motion in several axes, a simplified Constant score (functional ability) and the SF-36 quality of life score. RESULTS: Thirty patients (mean age: 56) underwent capsular distension. The Constant score was judged to be poor in over half of the patients. All the quality of life parameters were modified. When compared with P2, the P1 group showed a statistically significant improvement in terms of the pain score (p=0.005), anterior elevation (p=0.001), lateral elevation (p=0.005), external rotation (p=0.006) and the Constant score (p<0.001) one week after capsular distension. One year after capsular distension, this gain persisted in a statistically significant manner for all functional parameters and all SF-36 dimensions (p<0.001 for PF, RP, BP, SF and RE; p=0.01 for GH and VT and p=0.002 for MH). CONCLUSION: Our results show that capsular distension and subsequent intensive rehabilitation have a beneficial effect. This combination enables rapid, significant improvement from the first week onwards. The improvement phase lasts for one month and may hold steady for up to 12 months.